In the worlds of mainstream and alternative medicine, there are things called predictors of disease and predictors of injury. Health professionals have been made aware of these predictors through hundreds, possibly thousands of epidemiological studies over the last several decades.
These predictors do not guarantee that the disease or injury will occur. They simply provide us, the health professionals, additional information to aid in our assessments. We can take these predictors into account when considering a patients diagnosis, prognosis, etc.
There is one predictor of injury that is common for injuries such as neck pain, ankle sprains and low back pain. In fact, this predictor could almost be considered universal amongst any injury to the neuro-musculoskeletal system. It is a predictor of injury that stands out to me because I think it can be largely avoided. At the very least I think we should be able to decrease the likelihood of this predictor actually having and predictable value.
Any ideas on what it may be?
One of the most common predictors of injury is a history of prior injury.
In other words, you’re more likely to injure an area of your body if you’ve injured that same area in the past. Let’s run through the scenario of spraining an ankle.
Many people are familiar with the sensation of their foot rolling inwards when making a misstep on a hiking trail, sport field, etc. For the great majority of ankle sprains, this quick and alarming experience results in either the sudden correction of the ankle position and maintaining an upright posture or having the ankle submit to the inward turning motion with the weight of your body adding insult to injury.
In either case there will likely be varying degrees of tissue damage, pain, etc. Some of those who are able to correct their ankle position may be able to “walk-it-off” and may not see any need to follow the injury up with an assessment from someone in their health team. Others may have an ankle the size of a softball with little-to-no ankle mobility and significant pain with any kind of weight bearing activity. Most in the latter group will either go to the hospital or to one of their trusted healthcare providers for evaluation and management of the injury.
No matter how mild or severe in the injury, most healthcare practitioners and patients decide to discontinue treatment (read: Rest ≠ Recovery) of the sprain once the pain subsides and the individual no longer has difficulty walking.
But has the injury fully healed?
Is the ankle ready for the next soccer game?
A lack of pain and the ability to walk on a recently sprained ankle are not indicators of a completely healed injury. Resuming sports and other activities on the false premise that the once-injured tissues are back to normal is likely the biggest contributor for future injury.
What really causes this re-injury?
Specialized sensory cells called proprioceptors are found in tissues all over the body. They are responsible for letting you know where your body is in space. Close your eyes and bring your finger to your nose. Proprioceptors play an integral part in getting your finger to your nose successfully.The proprioceptors found in the tissues of the outer ankle are also damaged when the ankle is sprained. These cells are now unable to do their job as they should. The next time the ankle begins to roll inwards, the messages sent from these proprioceptors are delayed and the musculature surrounding the ankle is unable to correct the ankle position in a timely manner. Not only are you likely to re-sprain the ankle, the severity of the sprain may greatly increase.
There are a number of training methodologies that can both improve proprioception and tissue resilience around the ankle. Unfortunately, the rehabilitation within this context is usually stopped prematurely. Other factors may also be at fault such as simply underestimating the time needed for torn tissues to heal to the point of being as strong or stronger than they were prior to injury. The third and final stage of the healing response takes months, sometimes years.
Whether your injured tissues are an ankle or a low back, the risk of future injury generally boils down to still having some type of asymptomatic dysfunction (check out the “Four Pillars of Dysfunction”: here, here and here) present in the tissues even though the pain may have subsided. There is no magic pill treatment for any neuro-musculoskeletal injury. The rehabilitation process in virtually all injuries will take both diligence and patience. Food for thought!
Written By: Dr. Matthew Wentzell